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The Alabama High School Physical form is a vital document designed to ensure the safety and health of student-athletes participating in interscholastic sports. This form collects essential information, including the student’s personal details, medical history, and any pre-existing conditions that could affect their ability to compete. It requires comprehensive responses regarding past injuries, surgeries, and current health issues such as asthma or diabetes. Additionally, a physical examination conducted by a licensed physician is required to evaluate the athlete's physical fitness. This examination must be documented effectively, asserting that the student is cleared for participation in their chosen sport. The form also includes sections for the physician's recommendations, which could dictate the type of sports the student can engage in, if any restrictions apply. Overall, completing the Alabama High School Physical form is a crucial step for students and guardians, aiming to safeguard the well-being of young athletes while navigating the demands of competitive sports.

Alabama High School Physical Example

ALABAMA HIGH SCHOOL ATHLETIC ASSOCIATION

Revised 2018

Revised 2018

Preparticipation Physical Evaluation Form

 

History

Date_______________________

Name__________________________________________________ Sex ________ Age______ Date of birth _______________

Address ______________________________________________________________________ Phone______________________

School ________________________________________________________Grade __________ Sport ______________________

Explain “Yes” answers below:

 

 

 

 

 

Yes

No

1.

Has a doctor ever restricted/denied your participation in sports?

 

 

 

 

 

2.

Have you ever been hospitalized or spent a night in a hospital?

 

 

 

 

 

 

Have ever had surgery?

 

 

 

 

 

 

 

 

3.

Do you have any ongoing medical conditions (like Diabetes or Asthma)?

 

 

 

 

4.

Are you presently taking any medications or pills (prescription or over‐the‐counter?

 

5.

Do you have any allergies (medicine, pollens, foods, bees or other stinging insects)?

 

6.

Have you ever passed out during or after exercise?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Have you ever been dizzy during or after exercise?

 

 

 

 

 

 

 

 

Have you ever had chest pain or discomfort in your chest during or after exercise?

 

 

Do you tire more quickly than your friends during exercise?

 

 

 

 

 

 

 

Have you ever had high blood pressure?

 

 

 

 

 

 

 

 

Have you ever been told that you have a heart murmur, high cholesterol, or heart infection?

 

 

Have you ever had racing of your heart or skipped heartbeats?

 

 

 

 

 

 

Has anyone in your family died of heart problems or a sudden death before age 50?

 

 

Does anyone in your family have a heart condition?

 

 

 

 

 

 

 

Has a doctor ever ordered a test on your heart (EKG, echocardiogram)?

 

 

 

 

7.

Do you have any skin problems (itching, rashes, staph, MRSA, acne)?

 

 

 

 

 

8.

Have you ever had a head injury or concussion?

 

 

 

 

 

 

 

 

Have you ever been knocked out or unconscious?

 

 

 

 

 

 

 

 

Have you ever had a seizure?

 

 

 

 

 

 

 

 

 

Have you ever had a stinger, burner, pinched nerve, or loss of feeling or weakness in your arms or legs?

 

9.

Have you ever had heat or muscle cramps?

 

 

 

 

 

 

 

 

Have you ever been dizzy or passed out in the heat?

 

 

 

 

 

 

10. Do you have trouble breathing or do you cough during or after activity?

 

 

 

 

 

Do you take any medications for asthma (for instance, inhalers)?

 

 

 

 

 

11. Do you use any special equipment (pads, braces, neck rolls, mouth guard, eye guards, etc.)?

 

12. Have you had any problems with your eyes or vision?

 

 

 

 

 

 

 

Do you wear glasses or contacts or protective eye wear?

 

 

 

 

 

 

13. Have you had any other medical problems (infectious mononucleosis, diabetes, infectious diseases, etc.)?

 

14. Have you had a medical problem or injury since your last evaluation?

 

 

 

 

 

15. Have you ever been told you have sickle cell trait?

 

 

 

 

 

 

 

 

Has anyone in your family had sickle cell disease or sickle cell trait?

 

 

 

 

 

16. Have you ever sprained/strained, dislocated, fractured, broken or had repeated swelling or other

 

 

injuries of any bones or joints?

 

 

 

 

 

 

 

 

 

Head

Back

Shoulder

Forearm

Hand

Hip

Knee

Ankle

 

 

Neck

Chest

Elbow

Wrist

Finger

Thigh

Shin

Foot

 

17.When was your first menstrual period?__________________________________________________________________

When was your last menstrual period?___________________________________________________________________

What was the longest time between your periods last year?________________________________________________

Explain “Yes” answers:

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

I hereby state that, to the best of my knowledge, my answers to the above questions are correct.

Signature of athlete ___________________________________________________________ Date ___________________

Signature of parent/guardian __________________________________________________

FORM 5

DUPLICATE AS NEEDED

Rev. 2018 (The revised 2018 form is the official form accepted by the AHSAA.)

Page 1 of 2

Preparticipation Physical Evaluation Rule 1, Sec. 14 — In order for a student to be eligible for interscholastic athletics, there must be

on file in the Superintendent’s or Principal’s office a current physician’s statement certifying that

__________________________________________ the student has passed a physical exam, and that in the opinion of the examining physician (M.D.

 

 

 

Student's name

or D.O.) the student is fully able to participate in interscholastic athletics (Grade s 7‐12). The

 

 

 

AHSAA Physicians Certificate (Form 5 Rev. 2018) must be used. A physical exam will satisfy the

 

 

 

 

 

Physical Examination

requirement for one calendar year through the end of the month from the date of the exam. For

example, a physical given on May 5, 2019, will satisfy the requirement through May 31, 2020.

 

 

 

 

 

 

 

 

 

 

Height ____________ Weight _____________ BP _____ / _____ Pulse ____________

 

 

 

 

Vision R 20 / ____ L 20 / ____ Corrected: Y N

Revised 2018

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIMITED

 

Normal

 

 

Abnormal Findings

 

 

 

 

 

 

 

 

 

 

 

Cardiovascular

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pulses

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Heart

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lungs

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Skin

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E.N.T.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMPLETE

 

Abdominal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Genitalia (males)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Musculoskeletal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Neck

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Shoulder

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Elbow

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Wrist

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hand

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Back

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Knee

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ankle

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Foot

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Clearance:

A.Cleared

B.Cleared after completing evaluation/rehabilitation for: _______________________________________

C. Not cleared for:

Collision

 

 

 

Contact

 

 

 

Noncontact ____ Strenuous

____ Moderately strenuous

____ Nonstrenuous

Due to: ____________________________________________________________________________________________

Recommendation: _________________________________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

Name of physician ________________________________________________________________ Date ____________________

Address ________________________________________________________________________ Phone___________________

.

Signature of physician _____________________________________________________________, M.D. or D.O.

(Form must be signed and dated by the attending physician.)

Rev. 2018 (The revised 2018 form is the official form accepted by the AHSAA.)

Form Characteristics

Fact Name Description
Governing Law According to Rule 1, Sec. 14 of the Alabama High School Athletic Association (AHSAA) regulations, a current physician's statement is required for students participating in interscholastic athletics.
Age Requirement Students in grades 7-12 are eligible to participate in interscholastic athletics, provided they meet the physical examination requirements.
Frequency of Exam A physical examination is valid for one calendar year from the date it was conducted. Renewal is necessary to maintain eligibility.
Examiner Qualifications The evaluating physician must be either an M.D. (Medical Doctor) or a D.O. (Doctor of Osteopathic Medicine) for the form to be valid.
Physical Evaluation Requirement The AHSAA requires the use of the AHSAA Physicians Certificate (Form 5) to document the physical examination and findings.
Participation Clearance The physical examination will indicate if a student is 'cleared' or 'not cleared' for participation in specific types of athletic activities, influencing their eligibility.

Guidelines on Utilizing Alabama High School Physical

Filling out the Alabama High School Physical form is an essential step for participating in interscholastic athletics. The form captures important health information and ensures that the student is cleared for athletic activities. Proper completion of this form helps maintain the safety and well-being of student-athletes.

  1. Gather necessary personal information including the student’s name, sex, age, address, school, and grade.
  2. Carefully read through the health history questions. Be honest while selecting 'Yes' or 'No' for each question regarding past injuries or medical conditions.
  3. If you answer 'Yes' to any health question, provide detailed explanations in the spaces provided. Include the nature of the injury or condition and any treatments received.
  4. Provide the current date and the student’s date of birth and phone number.
  5. Select the sport(s) the student intends to participate in.
  6. Sign the form to confirm that the answers are accurate to the best of your knowledge. This signature is required from both the student and a parent or guardian.
  7. Ensure that a physician conducts a physical examination. Record findings, including height, weight, and any necessary evaluations.
  8. Document the physician's clearance status. Indicate if the student is cleared or has restrictions.
  9. Have the examining physician sign and date the form, providing their contact information.

What You Should Know About This Form

What is the purpose of the Alabama High School Physical form?

The Alabama High School Physical form is used to evaluate a student-athlete's health and readiness for participation in sports. It ensures that athletes do not have any medical conditions that could pose a risk during physical activity. By obtaining a signed physician’s statement, schools can confirm that a student has undergone a thorough examination and is fit to compete.

Who needs to complete the physical form?

All student-athletes in grades 7-12 who wish to participate in interscholastic athletics must complete the physical form. This requirement applies to both new participants and those who have previously participated in sports. The physical must be completed annually to ensure ongoing health and safety.

How often must the physical examination be conducted?

A physical examination must be conducted at least once each year. The evaluation is valid for one calendar year from the date of the examination. Athletes require a new form if a full year has passed since their last exam or if there have been significant changes in health status.

What information is collected in the physical form?

The physical form collects personal information such as the athlete's name, age, address, school, and grade. It also includes a detailed medical history section where the athlete must disclose any past injuries, surgeries, or ongoing health issues. The examining physician will assess various health indicators and complete a physical examination section of the form.

What happens if a student is not cleared for participation?

If a student is deemed not cleared for participation, the physician will specify the reasons. This may include restrictions based on the type of sport (e.g., contact vs. non-contact) or the intensity of participation. The student may need to undergo further evaluation, rehabilitation, or treatment before being eligible to participate in athletics.

Can parents or guardians complete the form on behalf of their child?

Parents or guardians may assist their child in completing the form, particularly with the medical history sections. However, a licensed physician (M.D. or D.O.) must conduct the physical examination and provide their signature on the form for it to be valid.

Where should the completed physical form be submitted?

The completed physical form should be submitted to the Superintendent's or Principal's office at the student's school. It is important that the form is on file prior to the student participating in any athletic activities. Schools may have their own deadlines for submission, so it is advisable to check in advance.

Common mistakes

Completing the Alabama High School Physical form can be a straightforward process, but several common mistakes can hinder the application. One significant issue is failing to provide complete personal information. This form requires accurate details, such as the student’s name, age, and school. Any missing or incorrect data can lead to delays in processing or even the rejection of the form.

Another mistake often made is neglecting to ask important health questions. The form contains various inquiries regarding past medical history, including injuries and illnesses. It is essential for both the athlete and their parent or guardian to take the time to answer these questions sincerely. Overlooking a "yes" answer regarding previous medical conditions could lead to serious health risks during athletic activities.

People also frequently misinterpret the need for specificity when explaining "yes" answers. For instance, if a student indicates they have experienced asthma, they should follow up with details about its frequency and severity. Clear explanations help physicians understand any potential risks associated with participation. A vague answer could result in inappropriate clearance for sports.

Additionally, signatures are sometimes overlooked. Both the athlete and the parent or guardian must sign the form to affirm that the information provided is accurate. Incomplete signatures will render the form invalid, preventing the athlete from participating in sports until the issue is rectified.

Another common error involves submitting the form without a current physician’s statement. This statement is crucial and must confirm that the student is medically cleared for sports. Ensure that a qualified medical professional has performed the examination and signed the form. Lack of this documentation can lead to ineligibility.

Lastly, individuals may not remember to check for any additional requirements listed by their specific school or school district. Each institution may have particular forms or additional documentation they require alongside the physical evaluation. Ignoring these specifications can cause unnecessary complications for the athlete's ability to join in athletic activities.

Documents used along the form

The Alabama High School Athletic Association (AHSAA) Preparticipation Physical Evaluation Form is an essential document for student-athletes. It requires a comprehensive review of the athlete’s medical history and a physical examination by a licensed physician. Other forms and documents often accompany this evaluation to ensure that students meet all necessary requirements for participation in sports.

  • AHSAA Physicians Certificate (Form 5): This form certifies that the athlete has passed a physical exam and is deemed fit to participate in sports. It includes the physician's recommendations and clearance statuses.
  • Sports Participation Consent Form: This document must be signed by the parent or guardian, giving permission for the student to participate in sports. It often includes a waiver of liability.
  • Emergency Contact Information Form: Parents or guardians provide up-to-date emergency contact information. This ensures that, in case of an emergency, quick action can be taken to reach the appropriate individuals.
  • Insurance Information Form: This form collects the athlete’s and their family’s health insurance details. It is crucial for providing necessary coverage in case of injuries during athletic activities.
  • Concussion Awareness Form: This document educates students and parents about the risks associated with concussions in sports. It usually requires signatures acknowledging understanding of concussion protocols.
  • Health History Form: While part of the physical evaluation, a detailed health history form is often requested separately. This form provides a deeper look into any prior injuries or medical issues affecting the athlete.
  • Drug Testing Consent Form: For some sports programs, students and their guardians may need to sign a consent form for random drug testing during the athletic season, ensuring compliance with anti-doping policies.
  • Code of Conduct Agreement: This form outlines behavior expectations for athletes. By signing, athletes agree to adhere to specific standards of conduct during their participation in sports programs.

Completing these documents carefully aids in ensuring compliance with AHSAA regulations. This process safeguards both the physical well-being of student-athletes and the integrity of the sports they participate in.

Similar forms

  • Student Health History Form: Similar to the Alabama High School Physical form, this document collects comprehensive medical history, including past injuries and medical conditions that may impact a student's ability to participate in sports.
  • Preparticipation Physical Evaluation (PPE) Form: This evaluation assesses an athlete's readiness for sports participation and corroborates required physical examinations from a healthcare provider.
  • Sports Physical Form: This document serves the same purpose as the Alabama High School Physical form, confirming that a student has undergone a physical exam to determine their ability to engage in athletics.
  • Athletic Participation Agreement: While focusing on the athlete's responsibilities and risks, this document may reference the need for a valid physical examination before participating in sports activities.
  • Immunization Records: Schools often require documentation of vaccinations, which ensures the athlete's overall health is accounted for before athletic participation.
  • Concussion Information Sheet: Similar in nature, this sheet outlines potential risks of concussions and requires acknowledgment from both the athlete and their guardian, complementing the physical form’s requirements.
  • Emergency Contact Form: This document identifies the individuals to contact in emergencies, ensuring safety during sports, similar to the standard of care established by the physical evaluation.
  • Insurance Information Form: This form collects data regarding the athlete's medical insurance, ensuring coverage is in place for any injuries that may occur during athletic activities.

Dos and Don'ts

  • Do: Fill out the form completely and accurately, providing all requested information.
  • Do: Include the athlete's date of birth for proper identification.
  • Do: Ensure all medical history questions are answered truthfully.
  • Do: Have a licensed physician complete the physical exam.
  • Do: Keep a copy of the completed form for your records.
  • Don't: Leave any sections blank; incomplete forms may delay approval.
  • Don't: Use shorthand or abbreviations that may confuse reviewers.
  • Don't: Forget to sign the form; both the athlete and parent/guardian should sign.
  • Don't: Alter or white-out any part of the form; corrections must be initialed by the physician.
  • Don't: Submit outdated forms; ensure the physical exam is current within the last year.

Misconceptions

  • Misconception 1: The physical form is only for students who are injured.
  • This form is not limited to students who have experienced injuries. It is a comprehensive evaluation meant for all athletes, regardless of their injury history. Every student participating in sports needs to ensure their physical readiness for competition.

  • Misconception 2: Only a doctor can complete the physical form.
  • While the final certification must be signed by a licensed physician (M.D. or D.O.), other health care providers can assist in gathering preliminary information and conducting parts of the evaluation. However, the physician’s signature is essential for validation.

  • Misconception 3: The form is only necessary for high school students.
  • This form is required for athletes in grades 7 through 12. Middle school students participating in school sports must also complete it. This ensures their safety and readiness for athletic competition at any level.

  • Misconception 4: Parents do not need to be involved in the physical evaluation.
  • Parental involvement is crucial. The form requires a signature from a parent or guardian, indicating their awareness and consent for their child's participation in sports. This also helps in maintaining communication regarding the athlete's health status.

  • Misconception 5: Once the physical is done, it does not need to be updated.
  • The physical examination is valid for one calendar year. After this period, a new evaluation is necessary to ensure that the athlete remains fit to participate in sports. Updating the form regularly is essential for their ongoing health and safety.

  • Misconception 6: The form is just a formality and does not have any real significance.
  • This form is a vital step in ensuring the health and safety of student-athletes. It helps identify any pre-existing conditions that may affect their ability to compete and ensures that they are physically prepared for the demands of their sport.

Key takeaways

Filling out the Alabama High School Physical form is an essential step for student-athletes who want to participate in sports. Below are some key takeaways that can help ensure a smooth experience with this important documentation.

  • Be Thorough and Honest: When completing the form, provide accurate information regarding medical history. Any past injuries or conditions should be disclosed as they can impact your ability to participate safely.
  • Understand the Importance of the Exam: A physical exam is not just a formality. It helps identify any potential health issues that might affect athletic performance or safety during sports activities.
  • Check for Expiration: The physical exam is valid for one calendar year. Keep track of the date to avoid any lapses in your eligibility to play sports at your school.
  • Follow-Up on Recommendations: If the physician includes recommendations or indicates that further evaluation is necessary, make sure to follow those instructions. Being proactive can help you meet the clearance requirements.
  • Required Signatures: Ensure that both the athlete and a parent or guardian sign the form. This emphasizes the importance of communication and agreement on the athlete's health status and readiness for sports.

By following these guidelines, you can make the process of filling out and utilizing the Alabama High School Physical form much simpler and more effective. Your health and safety should always come first when engaging in athletics.